Herpes simplex virus associated rhomboencephalitis mimicking demyelination: a case report

Area of Science:

• Neurology
• Infectious Diseases
• Neuroimmunology

Background:

• Herpes simplex virus (HSV) is an infrequent but significant cause of brainstem rhomboencephalitis.
• HSV presentation can mimic demyelinating disorders like MOGAD and NMOSD, creating diagnostic challenges.

Purpose of the Study:

• To report a case of HSV rhomboencephalitis presenting with symptoms mimicking demyelinating diseases.
• To highlight the importance of considering HSV in the differential diagnosis of brainstem syndromes.

Main Methods:

• A case of a 31-year-old male with neurological deficits including headache, numbness, and visual disturbances was analyzed.
• Diagnostic workup included MRI, CSF analysis (PCR for HSV, MOG, AQP4 antibodies), and VEP.
• Treatment involved initial methylprednisolone followed by intravenous acyclovir.

Main Results:

• MRI revealed pontine and cerebellar peduncle hyperintensities with trigeminal nerve enhancement.
• CSF showed lymphocytic pleocytosis; MOG and AQP4 antibodies were negative.
• HSV was confirmed by CSF PCR, and the patient improved significantly after intravenous acyclovir therapy.

Conclusions:

• This case emphasizes the need to include HSV rhomboencephalitis in the differential diagnosis for brainstem syndromes, especially those resembling demyelination.
• Early diagnosis and antiviral treatment are critical for preventing long-term neurological damage.